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The United States is one of eight countries where Maternal Morbidity is on the rise. In fact, our rate of maternal mortality has tripled since 1980. Defined as "maternal death that is associated with pregnancy or childbirth", America now has the highest rate of maternal mortality amongst developed countries. What a thing of horror.

There are several reasons that this is occurring, including an increased number of surgical deliveries (which are three times riskier than a vaginal delivery), complications from augmented labors, and dietary deficiencies leading to a rise in preeclampsia and eclampsia. This is only part of the list that we can see and study. But the particular issue I want to address today is that of rural healthcare, as maternal death is disproportionately high in rural areas.

Living in a very isolated area, I can attest to the state of rural maternal health in America today. The nearest hospital is 15 minutes away, a larger one is 40 minutes away, and the nearest urban hospital is an hour and a half drive. Due to the increasing cost of obstetric services in the US, the closest hospital had to stop offering them a decade ago. This has left people in my community with the option of driving 40 minutes to a hospital where OB services are offered by on-call family practice doctors OR drive the hour and a half to the "city" where there are in-house Obstetricians. Add into the equation that 5 months out of the year our area is shrouded in beautiful but dangerous driving conditions.

This situation leads women into a few undesirable predicaments:

delivering on the side of the road, back of an ambulance, in a rural unequipped Emergency Department OR

arriving at the hospital in early labor to find they are 2-3cm dilated and being admitted (they can't very well be sent home!). Subsequently, for every hour they spend in the hospital during early labor, their chances of interventions and surgical delivery increase.

Let us not forget that rural areas are often very impoverished areas. Many of these women cannot afford to travel the distance needed to receive prenatal care. This leads to missed visits (particularly at the end of pregnancy), and therefore, missed diagnoses of possibly fatal conditions such as pre-eclampsia (one of the big killers of mothers), hypertension, and fetal mal-position.

This is a serious problem. Thankfully, the gravity of this issue has caught the public eye:

International spokespersons are searching out solutions (such as Linda Robinson, who has an impactful TEDx talk on this topic).

The World Health Organization (WHO) has been one of the forerunners in offering possible solutions to Maternal Mortality. Along with AmnestyUSA and countless other respectable organizations, the WHO has offered that an increase in midwifery care will improve outcomes for mothers and babies worldwide, particularly in rural areas. Indeed, they have said that, "Increasing the number of midwives by 25% will reduce maternal mortality by 50%)." Properly trained midwives are a very feasible and effective solution to the problem of Maternal Morbidity. As French Obstetrician, Dr. Odent, has said,

“If we want to find safe alternatives to obstetrics, we must rediscover midwifery. To rediscover midwifery is the same as giving childbirth back to women.”

We, as Americans, need to re-evaluate maternal healthcare in this country. For most, birth is normal and natural, not a condition needing treatment. Do not for a moment imagine that interventions are conveniences without consequences.

For the 15% of women in this country who have high-risk pregnancies, I am deeply grateful for a medical system equipped to save lives. But for the 85% of women who are low-risk, having a baby is the epitome of wellness. Whether you deliver in or out of the hospital, be aware of the benefits and risks of both. We live in a country where we have many choices, be thankful for them and make wise decisions that are the most comfortable for you. This is your body and your baby and you have been given the intuition to care for both. Listen to your instincts, don't ignore them even if medical professionals do. Find care providers that you can trust and that trust you.

“Experiences have clearly shown that an approach which 'de-medicalizes' birth, restores dignity and humanity to the process of childbirth, and returns control to the mother is also the safest approach.” -Dr. Odent, MD, OBGYN

Women are natural worriers. In the childbearing years, this takes on many different faces and forms. If you are having trouble getting pregnant, worry can hang heavy like a cloud over every day, ranging from the more serious "What if I never get pregnant? Am I doing something wrong? Am I broken?" and leaking into the everyday, "Should I cut out gluten? Should I do more yoga to release stress?" If you are newly pregnant, the spectrum changes a little, but the underlying worry remains with its whole armory of weapons to steal your peace.

I love serving first-time moms because they are often very vocal about all the worries and fears that come up. Everything seems alarming and they want to do it all perfectly. I recall getting a phone call from a first time mom who was in a panic, "I went to a wedding and I ate 4-5 crackers with brie on them. When we got in the car, I realized that I'm not supposed to have soft cheeses and I'm freaking out. Should I make myself throw up?" Ah, yes, this fierceness is the stuff of motherhood.

Worry comes naturally but peace must be chosen & practiced. Here are some places to start:

The first is to recognize the worry and try to sniff out where its coming from. Acknowledge it, honor it, because it is something right about you. The worry itself is communicating something from within you. In the example above, the brie was threatening the safety of that woman's baby (at least in her head) and watch out, mama bear! You and I may laugh at the story and smile at the over-reaction, but at the end of the day, we need to respect the innate desire to protect and provide for the unborn child within her. Search out your worry-spots and try to discover the interior desire they reveal.

Secondly, cultivate trust. Trust in your situation, trust in your body, trust in your partner (if there is one), trust in the wondrous will to survive, trust in the Divine, trust that this beautiful life is made of chapters and you have the freedom to move into the unknown with a spirit of peace. This is cultivated by small daily choices, by breathing deeply into your insecurity and releasing it, and in this day and age, by choosing not to use Google as your life-guide (it will probably only scare you). Find people in your life who can impart wisdom to you, ask vulnerable questions of peers, surround yourself by those who place a great value in creating positivity. Embrace the wondrous innate ability your body has to grow and nurture another human being and give thanks that you have been created for this.

This last one is really important. Get comfy with not being in control. Worry is about control, or the lack thereof. Pregnancy is the concentrated stuff of the rest of parenting, the microcosm of the world of motherhood. You'll feel all of the "feels" that will come and go over the next many years of child-rearing - only in super uber duper intensity while you're pregnant. When a babe is growing within us, we imagine that we can keep them safe and make all the "right" decisions, we think we are in control. But ask any mother who has had a miscarriage or a difficult pregnancy or has carried past 40 weeks or had their birth preferences shredded into little pieces when labor came - we are only one part of a universal orchestra. When we give birth to these little ones, we send a large portion of our insides (and heart) to toddle unsteadily into the big world. The sooner we can learn the limitations of our control, the freer we will become to play our part really well and trust the Conductor to turn all the chaos into a perfect piece of music.

I don't prefer to be vulnerable. I don't like to appear "weak". Sit down with me and I will rationally discuss my feelings and my faults - but those deep raw emotions that make me human will mostly be hidden from view. Usually, I think before I feel. But, life has a way of outing us; sometimes gently like a flower unfolding to the sun, and sometimes forcefully like an ocean wave pulling the sands out to sea. As I get older, I am learning that my strength is not in looking poised and put-together, but in letting others see the struggle. Opening up, becoming raw, being vulnerable - this is the place where the self can become free because it has let others be a part of the journey. The other macho stuff - it's just crap.

This is my fourth postpartum journey. I am deeply grateful that I've had good pregnancies, wonderful deliveries, and contented newborns. But in this moment, all those hormones that grew a human inside of me have done back-flips and there's no ignoring the rainbow of emotions that are coursing through my being, changing at will, and leaking out my eyeballs without reason (or permission!). In pursuit of inner honesty, peace, and growth, I am going to let you in on this journey and perhaps you who have, are, or will walk this path will find encouragement.

Loneliness. There is a deep and piercing lonelines that fills the first few weeks after I give birth. It seeps into the quiet moments, the night wakings, the busyness of mealtime prep, even my beloved showers. It's not that type of loneliness that brings tears (though those abound), but it has this aching longing for something or someone. It is frightened of change and even more terrified of static. It is somewhat directionless and more often than not, lacks an object. Words elude it, like it doesn't want to be described. And for me, things that I can't find words for feel like a trapped flock of birds inside and cause a restlessness reminiscent of that pesky restless leg syndrome I get during pregnancy. I feel empty in my depths.

Today I have paused and found a mindful place to simply feel this loneliness. Not to fight it, just to let it saturate. Slowly, I have searched it out. I have followed it to the corners of myself and discovered something. In the past, I have been afraid of this loneliness and my fear of it has paralyzed me. I've stuffed it and let time pass, and eventually, it would fade as life resumed itself. But this time, I am feeling it and embracing what comes. What I have unearthed is priceless to me. This loneliness is normal and natural and very very good because:

For nine months, I have nourished and nurtured and protected and guarded another human being - the body, soul, and mind of a PERSON. I have undergone the discomforts of pregnancy because the preciousness of this life was greater and more important than my temporal comfort. I have LOVED what I hadn't seen and received the love and trust of this small person inside. The loneliness comes because this human that grew inside of me is a separate SELF from me. The exchange of energy and love was perfect and whole because this separate self was breathed from the Divine and given a LIFE of her own. And now, so suddenly, she is outside of me and it makes my insides ache with the most beautiful loneliness I could ever imagine.

I have come to a place where I can HONOR this loneliness in its painful depths because it reveals something that is MARVELOUS about my inner self.

So now, as I find some words and as tears flow, I find my mother was right when she told me not to fight the hormones, "feel and let them run their course". Wise words from a woman who walked this mothering path with joy six times over. My journey is not over and as I heed my mother's advice and feel all the feels, perhaps I will discover more truth to share with you. For now, I give thanks for the depths.

"For you created my inmost being; you knit me together in my mother's womb."